Management of Bilateral Condylar Fracture With ORIF Using the Puppet Technique in the Adolescence: A Case Report

Condyle fracture may result in functional and cosmetic issues. Malocclusion becomes one of the adverse effects of the fracture that impairs the quality of life. It is crucial for maintaining the mandibular condyle because it is an essential component of jaw movement. The critical decision for the treatment choice in early adolescence has an impact on accurate reduction and rigid fixation. Improper methods of therapy might have major consequences for facial growth and development, with ankylosis as a frequent occurrence.

To report a case of bilateral condylar fracture in pediatrics and its management and long-term follow-up.

A 16-year-old male was referred to the Oral and Maxillofacial Surgery Department after a road traffic accident with complains of pain in the area of TMJ bilaterally. The clinical examination showed an anterior open bite and restricted mandibular movement. CT scan reported a bilateral fracture at the neck condyle, as well as on the right side of the coronoid process, the right side of the symphysis, and the left side angle of the mandible.

Open reduction internal fixation (ORIF) and the puppet technique are performed under general anesthesia. Temporary immobilization methods involve arch bars and heavy elastics. Intraoral, submandibular, and miniretromandibular incisions were given concerning the fracture site. A 3-year follow-up revealed an occlusion, facial growth, and bone union, which followed the removal of the surgical miniplate.

The patient achieved bone union, occlusal stability, facial development, and recovery of jaw movement on both sides. The treatment also successfully maintains vertical dimensions, which are key to treating such cases.